Cancer screening exams can help find gallbladder cancer at its earliest stage when the chances for successful treatment, optimal outcomes and fewer side effects are greatest. These tests are usually done when a patient is healthy and has no specific symptoms. Unlike some cancers, gallbladder cancer has no reliable early indicators that doctors can use to screen for the cancer.

Not only are expert cancer researchers at the OSUCCC – James continually working to detect and diagnose gallbladder cancer early, but they are also developing additional tests to detect and diagnose cancer even earlier, leading to improved outcomes, faster responses and fewer side effects.

Gallbladder & Bile Duct Cancer Risk Factors

A risk factor is anything that increases your risk of getting gallbladder cancer. Women develop gallbladder cancer more often than men do, for example. People of Native American or Mexican descent are also at increased risk. The disease occurs much more often in Asia, Eastern Europe and South America. Other risk factors include:

  • Obesity
  • Gallstones
  • Older age
  • Polyps in the gallbladder
  • Bile duct abnormalities or cysts

Risk Factors for Bile Duct Cancer

People who have several liver or bile duct diseases have higher risk of bile duct cancer because their bile ducts are chronically inflamed. These diseases include:

  • Primary sclerosing cholangitis
  • Chronic ulcerative colitis
  • Choledochal cysts
  • Infection with a parasite (liver fluke) that occurs in Asian countries as a result of eating raw fish

(Source: National Cancer Institute)

Diagnosing Gallbladder & Bile Duct Cancers

A doctor considers a patient’s symptoms and medical and family history when checking for signs of gallbladder disease. Indications may include unusual lumps in the abdomen or yellowing of the skin.

Doctors may use several types of tests to diagnose and stage gallbladder cancer.

Blood & Laboratory Tests


Liver Function

A blood sample is analyzed to measure substances in your blood released by the liver. A higher than normal amount of a substance can be a sign of liver disease caused by gallbladder cancer.

Blood Chemistry Analysis

A blood sample is analyzed to measure substances in your blood. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.

Imaging Exams


Computed Tomography (CT) Scan

Computed tomography (CT) uses X-rays to produce detailed images of the body. A dye may be injected into your vein or you might be asked to swallow a mix with dye to help abdominal organs or tissues show up more clearly.

Ultrasound Exam

Ultrasound uses sound waves instead of X-rays to evaluate the organs and spaces inside the abdomen.

Endoscopic Ultrasound

This procedure uses ultrasound waves to produce images of organs and tissues inside the abdomen. A doctor also can biopsy a tumor found this way while using the endoscope.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) uses a high-powered magnet and radio waves to produce detailed images of the body.

Positron Emission Tomography (PET) Scan

Called a PET scan, positron emission tomography uses a small amount of a radioactive agent and a special imaging camera to identify areas of cancerous activity in the body. Cancerous cells appear brighter on PET images.

Percutaneous Transhepatic Cholangiography (PTC)

This procedure uses X-rays and a special injected dye to analyze liver and bile ducts. If a blockage is found, the physician may insert a small stent in the liver to drain bile.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

This procedure uses an endoscope to create X-ray images of the pancreatic ducts. The images show areas of the ducts that are blocked or narrowed. While the endoscope is in place, the physician can place a tiny tube called a stent in the ducts to open them and take samples of the tissue for biopsy.

Chest X-ray

This is an X-ray of the organs and bones inside the chest.

Exploratory Surgery: Laparoscopy

A surgeon inserts a thin, lighted tube through a small incision in the patient’s abdomen to inspect the inside of the abdomen on a monitor to guide the surgeon to the gallbladder or other organs to evaluate them and to take samples for biopsy.

Biopsy

Tissue from the gallbladder and bile duct can be analyzed under a microscope for diagnosis and staging of gallbladder and bile duct cancer. Tissue for a biopsy also can be collected from the gallbladder or bile duct using a special needle. Needle biopsies do not require patients to have surgery or general anesthesia.

Tumor Marker Test

A sample of blood, urine or tissue is analyzed to measure substances made by organs, tissues or tumor cells in the body. Certain substances are linked to specific types of cancer. These are called tumor markers. Higher than normal levels of CEA and CA 19-9 are associated with extrahepatic bile duct cancer.

(Source: National Cancer Institute)

Staging Gallbladder Cancer

Some tests are conducted to help doctors stage gallbladder cancer. Your treatment and outlook are based partly on the stage of your cancer.

Stage 0

In stage 0, abnormal cells are found in the inner (mucosal) layer of the gallbladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and has spread beyond the inner (mucosal) layer to a layer of tissue with blood vessels or to the muscle layer.

Stage II

In stage II, cancer has spread beyond the muscle layer to the connective tissue around the muscle.

Stage IIIA

In stage IIIA, cancer has spread through the thin layers of tissue that cover the gallbladder and/or to the liver and/or to one nearby organ, such as the stomach, small intestine, colon, pancreas or bile ducts outside the liver.

Stage IIIB

In stage IIIB, cancer has spread to nearby lymph nodes and:

  • Beyond the inner layer of the gallbladder to a layer of tissue with blood vessels or to the muscle layer; or
  • Beyond the muscle layer to the connective tissue around the muscle; or
  • Through the thin layers of tissue that cover the gallbladder and/or to the liver and/or to one nearby organ, such as the stomach, small intestine, colon, pancreas or bile ducts outside the liver

Stage IVA

In stage IVA, cancer has spread to a main blood vessel of the liver or to two or more nearby organs or areas other than the liver. Cancer may have spread to nearby lymph nodes.

Stage IVB

In stage IVB, cancer has spread to either:

  • Lymph nodes along large arteries in the abdomen and/or near the lower part of the backbone; or
  • To organs or areas far away from the gallbladder

Gallbladder cancer also can be grouped according to how physicians plan to treat the cancer. There are two treatment groups:

Localized (Stage I)

Cancer is found in the wall of the gallbladder and can be completely removed by surgery.

Unresectable, Recurrent or Metastatic (Stage II, Stage III & Stage IV)

  • Unresectable cancer cannot be removed completely by surgery. Most patients with gallbladder cancer have unresectable cancer
  • Recurrent cancer is cancer that has recurred (come back) after it has been treated. Gallbladder cancer may come back in the gallbladder or in other parts of the body
  • Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body. Metastatic gallbladder cancer may spread to surrounding tissues, organs, throughout the abdominal cavity or to distant parts of the body

(Source: National Cancer Institute)

Staging Bile Duct Cancer

Physicians may use one of two staging systems for bile duct cancer, depending on where the cancer first forms.

The following stages are used for perihilar extrahepatic bile duct cancer:

Stage 0

In stage 0, abnormal cells are found in the innermost layer of tissue lining the perihilar bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed in the innermost layer of the wall of the perihilar bile duct and has spread into the muscle and fibrous tissue of the wall.

Stage II

In stage II, cancer has spread through the wall of the perihilar bile duct to nearby fatty tissue or to the liver.

Stage III

Stage III is divided into stages IIIA and IIIB.

  • Stage IIIA: The tumor has spread to one branch of the hepatic artery or of the portal vein
  • Stage IIIB: The tumor has spread to nearby lymph nodes. Cancer has also spread into the wall of the perihilar bile duct and may have spread through the wall to nearby fatty tissue, the liver or to one branch of the hepatic artery or of the portal vein

Stage IV

Stage IV is divided into stages IVA and IVB.

  • Stage IVA: The tumor may have spread to nearby lymph nodes and has spread to one or more of the following:
    • The main part of the portal vein or both branches of the portal vein
    • The hepatic artery
    • The right and left hepatic ducts
    • The right hepatic duct and the left branch of the hepatic artery or of the portal vein
    • The left hepatic duct and the right branch of the hepatic artery or of the portal vein
  • Stage IVB: The tumor has spread to other parts of the body, such as the liver.

The following stages are used for distal extrahepatic bile duct cancer:

Stage 0

In stage 0, abnormal cells are found in the innermost layer of tissue lining the distal bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. Stage I is divided into stages IA and IB.

  • Stage IA: Cancer is found in the distal bile duct only
  • Stage IB: Cancer has spread all the way through the wall of the distal bile duct

Stage II

Stage II is divided into stages IIA and IIB.

  • Stage IIA: Cancer has spread from the distal bile duct to the gallbladder, pancreas, small intestine or other nearby organs
  • Stage IIB: Cancer has spread from the distal bile duct to nearby lymph nodes. Cancer may have spread through the wall of the distal bile duct or to the gallbladder, pancreas, small intestine or other nearby organs

Stage III

In stage III, cancer has spread to the large vessels that carry blood to the organs in the abdomen. Cancer may have spread to nearby lymph nodes.

Stage IV

In stage IV, cancer has spread to other parts of the body, such as the liver or lungs.

Extrahepatic bile duct cancer can also be grouped according to how the cancer may be treated. There are two treatment groups:

Localized & Resectable

The cancer is in an area where it can be removed completely by surgery.

Unresectable, Recurrent or Metastatic

  • Unresectable cancer cannot be removed completely by surgery. Most patients with extrahepatic bile duct cancer have unresectable cancer
  • Recurrent cancer is cancer that has recurred (come back) after it has been treated. Extrahepatic bile duct cancer may come back in the bile duct or in other parts of the body
  • Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body; metastatic extrahepatic bile duct cancer may have spread to nearby blood vessels, the liver, the common bile duct, nearby lymph nodes, other parts of the abdominal cavity or to distant parts of the body

(Source: National Cancer Institute)

 

If you have received a gallbladder or bile duct cancer diagnosis, or if you want a second opinion or just want to speak to a gallbladder or bile duct cancer specialist, we are here to help you. Call 800-293-5066 or 614-293-5066 to make an appointment.

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